Impact of Tactile Sensation on Dexterity: A Cross-Sectional Study of Patients With Impaired Hand Function After Stroke

The authors sought to explore the impact of tactile sensation on manual dexterity and the validity of the strength-dexterity test in subjects with chronic impairments after stroke in a cross-sectional study of 24 patients with impaired hand function after stroke. Dexterity was assessed by the strength-dexterity test, Box and Blocks, and Nine-Hole Peg Test, and the ABILHAND questionnaire. Sensation was measured by pinprick, cotton-wool, graphesthesia, and 2-point discrimination tests. Sensation in the paretic hand had strong association with paretic hand performance in the strength-dexterity test and Nine-Hole Peg Test and explained 13% of the variance. Sensation in the nonparetic hand was associated with the results of the ABILHAND questionnaire. Among sensory tests, 2-point discrimination had the strongest association with dexterity tests. No significant correlations between sensation, pinch force, and dexterity tests were found for the nonparetic hand. The strength-dexterity test exhibited strong correlations with the other dexterity measures and with pinch force. There is an association between tactile sensation and dexterous performance in the paretic hand; activity level performance is associated with sensation in the nonparetic hand. The study supports the validity of the strength-dexterity test when applied in subjects in the chronic stage after stroke.     

The development of hand preference in children: The effect of task demands and links with manual dexterity

Lateralisation of hand preference and manual dexterity are known to develop over childhood, while in adulthood strength of hand preference has been shown to interact with extrinsic task demands. Some evidence exists to suggest that strength of hand preference and motor skill may be related. In the current study a handedness inventory, midline crossing (QHP) and peg-moving tasks were used to investigate: (1) the development of hand preference between 4 and 11 years; (2) whether extrinsic task demands affect strength of hand preference, and (3) whether strength of hand preference was associated with manual dexterity. Younger children (4–5 years) showed weak hand preference in comparison to older children (8–11 years), and extrinsic task demands influenced willingness to cross the body’s midline with the preferred hand. Age and peg-moving speed were associated with midline crossing in certain task conditions. Overall, results suggest a coupling between manual dexterity and brain maturation in typical development.     

An investigation of finger and manual dexterity

In ergonomics, handgrip has been perceived as one of the most important hand functions; however, other types of functions of the hand are also important to the ergonomist, such as finger and manual dexterity, on which few ergonomic studies have been done. This experiment involved 60 male and female college students whose performance (number of pegs placed into a board in 30 sec.) of finger dexterity were statistically significantly different between the right and left hands and between women and men. The interaction of hand and sex was significant.     

Multifractal foundations of visually-guided aiming and adaptation to prismatic perturbation

Visually-guided action of tossing to a target allows examining coordination between mechanical information for maintaining posture while throwing and visual information for aiming. Previous research indicates that relationships between visual and mechanical information persist in tossing behavior long enough for mechanical cues to prompt recall of past visual impressions. Multifractal analysis might model the long-term coordinations among movement components as visual information changes. We asked 32 adult participants (6 female, 25 male, one not conforming to gender binary; aged M = 19.77, SD = 0.88) to complete an aimed-tossing task in three blocks of ten trials each. Block 1 oriented participants to the task. Participants wore right-shifting goggles in Block 2 and removed them for Block 3. Motion-capture suits collected movement data of the head, hips, and hands. According to regression modeling of tossing performance, multifractality at hand and at hips together supported use of visual information, and adaptation to wearing/removing of goggles depended on multifractality across the hips, head, and hands. Vector-autoregression modeling shows that hip multifractality promoted head multifractality but that hand fluctuations drew on head and hip multifractality. We propose that multifractality could be an information substrate whose spread across the movements systems supports the perceptual coordination for the development of dexterity.     

Spatial limits on the nonvisual self-touch illusion and the visual rubber hand illusion: Subjective experience of the illusion and proprioceptive drift

The nonvisual self-touch rubber hand paradigm elicits the compelling illusion that one is touching one’s own hand even though the two hands are not in contact. In four experiments, we investigated spatial limits of distance (15 cm, 30 cm, 45 cm, 60 cm) and alignment (0°, 90° anti-clockwise) on the nonvisual self-touch illusion and the well-known visual rubber hand illusion. Common procedures (synchronous and asynchronous stimulation administered for 60 s with the prosthetic hand at body midline) and common assessment methods were used. Subjective experience of the illusion was assessed by agreement ratings for statements on a questionnaire and time of illusion onset. The nonvisual self-touch illusion was diminished though never abolished by distance and alignment manipulations, whereas the visual rubber hand illusion was more robust against these manipulations. We assessed proprioceptive drift, and implications of a double dissociation between subjective experience of the illusion and proprioceptive drift are discussed.     

Difference of motor overflow depending on the impaired or unimpaired hand in stroke patients

The aim of this study was to investigate the patterns of contralateral motor overflow (i.e. mirror movement) between the homologous body parts on the right and left side, in stroke patients during single-finger and multi-finger maximum force production tasks. Forty subjects, including stroke (n = 20) and normal subjects (n = 20), participated in this study. The stroke subjects maximally pressed force sensors with their fingers in a flexed position using a single (index, middle, ring, or little) or all fingers (all 4 fingers) using the impaired (IH) or unimpaired (UIH) hand, while the non-patient subjects used their right hands for the same tasks. The maximal voluntary forces in the ipsilateral and unintended pressing forces of each contralateral finger were recorded during the tasks. The magnitude of motor overflow to the contralateral side was calculated using the index of contralateral independence (CI). During the single finger tasks, the finger CI was significantly decreased in the UIH (91%) compared with that in the IH (99%) or normal hands (99%). Likewise, the multiple finger tasks showed that the CI was significantly lower in the UIH (84%) compared with that in the IH (96%) or normal hands (99%). However, the maximal forces were significantly lower in the IH relative to those in the UIH and normal hands. These data demonstrate that stroke patients have greater motor overflow from the UIH to the IH.     

Kinematic parameters of hand movement during a disparate bimanual movement task in children with unilateral Cerebral Palsy

Children with unilateral Cerebral Palsy (uCP) experience problems performing tasks requiring the coordinated use of both hands (bimanual coordination; BC). Additionally, some children with uCP display involuntary symmetrical activation of the opposing hand (mirrored movements). Measures, used to investigate therapy-related improvements focus on the functionality of the affected hand during unimanual or bimanual tasks. None however specifically address spatiotemporal integration of both hands. We explored the kinematics of hand movements during a bimanual task to identify parameters of BC. Thirty-seven children (aged 10.9 ± 2.6 years, 20 male) diagnosed with uCP participated. 3D kinematic motion analysis was performed during the task requiring opening of a box with their affected- (AH) or less-affected hand (LAH), and pressing a button inside with the opposite hand. Temporal and spatial components of data were extracted and related to measures of hand function and level of impairment. Total task duration was correlated with the Jebsen–Taylor Test of Hand Function in both conditions (either hand leading with the lid-opening). Spatial accuracy of the LAH when the box was opened with their AH was correlated with outcomes on the Children’s Hand Use Experience Questionnaire. Additionally, we found a subgroup of children displaying non-symmetrical movement interference associated with greater movement overlap when their affected hand opened the box. This subgroup also demonstrated decreased use of the affected hand during bimanual tasks. Further investigation of bimanual interference, which goes beyond small scaled symmetrical mirrored movements, is needed to consider its impact on bimanual task performance following early unilateral brain injury.     

Effector-specific visual information influences kinesthesis and reaction time performance in Parkinson's disease

Twelve patients diagnosed with idiopathic Parkinson's disease and 11 age-matched control participants performed a continuous bimanual wrist flexion-extension tracking task while vision of their hands was manipulated. Participants were required to match the frequency and amplitude of movements of 1 limb that was driven at 0.6 Hz by a torque motor by actively moving the contralateral limb. In half the trials, the more affected limb (subdominant for controls) was driven, and in the other half, the less affected limb (dominant for controls) was driven. Vision of both hands, vision of the driven hand only, vision of the active hand only, or no vision of the hands was allowed. Simple and probe reaction times were assessed. Parkinson's disease patients performed the tracking task to a reasonable level of temporal and spatial accuracy as compared with control participants in terms of hand phasing and root mean square error. Patients demonstrated a marked posture deviation (toward flexion), which was exaggerated when the less affected limb was active. Amplitude deviations were smaller in both groups when the less affected (dominant) limb was active and when participants had vision of the driven hand. Overall, patients delivered slower responses in both simple and probe conditions. Reaction times of Parkinson's disease patients who were allowed vision of only the active hand were longer than were those of patients in all other visual conditions, whereas visual conditions did not affect the reaction times of control participants. The authors conclude that central demands increase when movement regulation must be based solely on kinesthetic information and when vision directs attention away from the most relevant source of kinesthetic information.     

When two limbs are weaker than one: Sensorimotor syncopation with alternating hands

This study addresses the demands of alternating bimanual syncopation, a coordination mode in which the two hands move in alternation while tapping in antiphase with a metronomic tone sequence. Musically trained participants were required to engage in alternating bimanual syncopation and five other coordination modes: unimanual syncopation where taps are made (with the left or right hand) after every tone; unimanual syncopation where taps are made after every other tone; bimanual synchronization with alternating hands; unimanual synchronized tapping with every tone; and unimanual tapping with every other tone. Variability in tap timing was greatest overall for alternating bimanual syncopation, indicating that it is the most difficult. This appears to be due to instability arising from the simultaneous presence of two levels of antiphase coordination (one between the pacing sequence and the hands, the other between the two hands) rather than factors relating to movement frequency or dexterity limits of the nonpreferred hand.     

Upper limb proprioception and fine motor function in young pianists

BackgroundThis study investigated if intensive piano training may be associated with improved motor and somatosensory function. We systematically examined upper limb proprioception, which is known to play an essential role in skill movements, and motor function in young pianists.MethodForty-four typically developing children who either regularly played piano for more than six years (N = 16) or had no experience playing musical instruments (N = 28) participated. Elbow and wrist joint proprioceptive acuity was assessed using a manipulandum. The wrist/elbow was passively flexed to a target with participants actively trying to match the just experienced target position. Motor function was assessed using the Movement Assessment Battery for Children (MABC-2).ResultsFirst, children in the pianist group exhibited significantly lower position sense bias (systematic error) at both the elbow and wrist when compared to controls. Position sense precision (random error) was not different between groups. Second, the piano group exhibited enhanced fine motor function as shown by higher manual dexterity MABC-2 scores. Performance in other motor domains (aiming and catching or balance) was not improved in young pianists. Third, a lower position sense bias was correlated with a higher level of manual dexterity.ConclusionThis study documents that children who regularly play the piano have superior upper limb position sense acuity. Specifically, smaller position sense bias, i.e., less systematic error. Superior upper position sense acuity in young pianists is associated with higher fine motor functions.     

The role of somatosensory stimulation in social phobia—An analysis of hand coordination in patients and therapeutic dyads during psychodynamic psychotherapy

In the psychotherapeutic treatment of social phobia, the hand movement behaviour exhibited during the interaction provides information about the success of the therapy. In particular, the degree of mutual somatosensory stimulation of the hands (hands moving on each other, as a unit, apart) appears to be relevant regarding the patient's mental state. To test this hypothesis, the present study investigates hand coordination in the course of psychotherapy in patients with and without symptom improvement and in the corresponding therapeutic dyads. Forty-two videos of patient–therapist dyads consisting of 21 patients (n = 11 non-improved; n = 10 improved; according to Liebowitz Social Anxiety Scale self-assessment) from the Social Phobia Research Network project were investigated in early psychotherapy sessions and in pre-last sessions. Hand movements of four randomised video sequences per dyad were analysed with NEUROGES^®-ELAN. Patients with non-improved symptoms displayed shorter act apart coordination and more act on each other coordination than patients with improved symptoms. Patients displayed more act apart and act on each other and less act as a unit coordination than therapists. In therapeutic dyads, act on each other coordination in early sessions, as well as short act apart coordination, was significantly related to non-improvement. Patients with non-improved symptoms are characterised by more hand coordination associated with a high degree of somatosensory stimulation serving self-regulation (act on each other), as well as short complex gestural expressions (act apart). Thus, hand coordination constitutes a progression and outcome parameter informing on somatosensory stimulation.     

Does functional performance and upper body strength predict upper extremity reaction and movement time in older women?

BackgroundReaction time to initiate upper limb movement and movement time to place hands on the landing surface may be important factors in forward fall landing and impact, contributing to injury reduction. The aim was to investigate the relationship of physical function and upper body strength to upper limb reaction and movement time in older female participants.Methods75 female participants (72 ± 8 yrs) performed 5 arm response trials. Reaction time (signal to initiation of movement), and movement time (initial movement to contact), were collected using 3D motion capture. Additional variables were: handgrip; sit-to-stand; shoulder flexion and elbow extension strength measured by hand-held dynamometry; one-legged balance; fall risk; and physical activity scores. Prediction variables for reaction and movement time were determined in separate backward selection multiple regression analyses. Significance was set at P < 0.05.FindingsSignificant regression equations for RT (r² = 0.08, P = 0.013) found a relationship between stronger handgrip (Beta = −0.002) and faster reaction time, accounting for 8% variance. For movement time (r² = 0.06, P = 0.036) greater shoulder flexion strength (Beta = −0.04) was related to faster movement time, explaining 6% variance. Stronger SF strength was related to a decrease in MT by 4%.DiscussionA relationship between arm strength measures and faster upper body reaction and movement time was shown, with 10–20% higher strength associated with a 5% faster response time. Even though this was a relatively weak relationship, given that strength is a modifiable component this provides a potential avenue for future intervention efforts. This in turn could have an impact on forward fall landing and potential reduction of injury risk.     

Cognitive process-based subtypes of developmental coordination disorder (DCD)

The purpose of the study was to identify the cognitive subtypes demonstrated by children with developmental coordination disorder (DCD) using the Planning-Attention-Simultaneous-Successive Processing (PASS) theory and the Cognitive Assessment System (D-N CAS). Participants were 108 children aged 5- and 6-years old, 54 with DCD and 54 without DCD, all attending typical kindergartens. They were examined on 31 cognitive-motor variables. Hierarchical-agglomerative and iterative partitioning cluster analyses including 9 motor and 7 cognitive variables revealed the following six subtypes:

• oC1 = children at risk (having considerable difficulty with jumping and minor difficulty with manual dexterity and simultaneous coding);
• oC2 = children on the mean (all cognitive-motor scores close to the mean);
• oC3 = free from cognitive-motor problems (all scores above average);
• oC4 = manual dexterity, planning and simultaneous coding difficulties;
• oC5 = manual dexterity, dynamic balance, and planning difficulties;
• oC6 = generalized cognitive-motor dysfunction (all scores considerably below average).

It is well known that DCD is a heterogeneous condition. However, whenever cognitive processes were lower than average, cognitive-motor relationship was evident in subgroups C1, C4, C5 and C6. Early identification of task-specific cognitive-motor difficulties may be essential for early educational intervention practices in order to anticipate and improve learning, academic and performing difficulties.     

Psychometric properties of the Norwegian version of the Childhood Trauma Questionnaire in high‐risk groups

The Childhood Trauma Questionnaire ‐ Short Form (CTQ‐SF) is widely used to measure childhood abuse of all types. In the present study, we examined the psychometric properties of the Norwegian version of the instrument. The participants constituted four subsamples (n = 517): substance abusers (n = 126), psychiatric patients (n = 210), prisoners (n = 109) and adolescents in out‐of‐home placements (n = 72). Confirmatory factor analysis revealed a reasonable fit of the data to the original five‐factor structure of the CTQ‐SF. Measurement invariance was found across gender and the four subsamples. It was concluded that the Norwegian version of the CTQ‐SF has acceptable psychometric properties, with good reliability and satisfactory accuracy, to assess different dimensions of childhood trauma.     

Planning Maximally Smooth Hand Movements Constrained to Nonplanar Workspaces

The article characterizes hand paths and speed profiles for movements performed in a nonplanar, 2-dimensional workspace (a hemisphere of constant curvature). The authors assessed endpoint kinematics (i.e., paths and speeds) under the minimum-jerk model assumptions and calculated minimal amplitude paths (geodesics) and the corresponding speed profiles. The authors also calculated hand speeds using the 2/3 power law. They then compared modeled results with the empirical observations. In all, 10 participants moved their hands forward and backward from a common starting position toward 3 targets located within a hemispheric workspace of small or large curvature. Comparisons of modeled observed differences using 2-way RM-ANOVAs showed that movement direction had no clear influence on hand kinetics (p < .05). Workspace curvature affected the hand paths, which seldom followed geodesic lines. Constraining the paths to different curvatures did not affect the hand speed profiles. Minimum-jerk speed profiles closely matched the observations and were superior to those predicted by 2/3 power law (p < .001). The authors conclude that speed and path cannot be unambiguously linked under the minimum-jerk assumption when individuals move the hand in a nonplanar 2-dimensional workspace. In such a case, the hands do not follow geodesic paths, but they preserve the speed profile, regardless of the geometric features of the workspace.     

Correlation between tests of attention and performance on grooved and Purdue pegboards in normal subjects

This study investigated the relation between tests of manual dexterity and attentional functions with 49 normal, right-handed medical students (26 women, 23 men, ages 19-30 years) who were assessed with a Purdue Pegboard Test, Grooved Pegboard Test, and a Test for Attentional Performance, comprising measures of tonic and phasic alertness and divided attention. Weak to moderately high partial correlations controlling for finger size were obtained between pegboard test performance of the left hand and phasic alertness (r = .31-.50). Purdue Pegboard Assembly subtest scores were weakly correlated with divided attention (r = -.39). These findings suggest that attention is an important determinant of performance for manual dexterity tests of the nondominant hand.     

Upper limb movement analysis during gait in multiple sclerosis patients

PurposeGait disorders in multiple sclerosis (MS) are well studied; however, no previous study has described upper limb movements during gait. However, upper limb movements have an important role during locomotion and can be altered in MS patients due to direct MS lesions or mechanisms of compensation. The aim of this study was to describe the arm movements during gait in a population of MS patients with low disability compared with a healthy control group.MethodsIn this observational study we analyzed the arm movements during gait in 52 outpatients (mean age: 39.7 ± 9.6 years, female: 40%) with relapsing-remitting MS with low disability (mean EDSS: 2 ± 1) and 25 healthy age-matched controls using a 3-dimension gait analysis.ResultsMS patients walked slower, with increased mean elbow flexion and decreased amplitude of elbow flexion (ROM) compared to the control group, whereas shoulder and hand movements were similar to controls. These differences were not explained by age or disability.ConclusionUpper limb alterations in movement during gait in MS patients with low disability can be characterized by an increase in mean elbow flexion and a decrease in amplitude (ROM) for elbow flexion/extension. This upper limb movement pattern should be considered as a new component of gait disorders in MS and may reflect subtle motor deficits or the use of compensatory mechanisms.     

Neurocognitive functioning in patients with conversion disorder/functional neurological disorder

Neurocognitive symptoms are common in individuals with somatic symptom and related disorders (SSRD), but little is known about the specific impairments in neurocognitive domains in patients with conversion disorder (CD)/functional neurological disorder (FND). This study examines neurocognitive functioning in patients with CD/FND compared to patients with other SSRD. The sample consisted of 318 patients. Twenty-nine patients were diagnosed with CD/FND, mean age 42.4, standard deviation (SD) = 13.8 years, 79.3% women, and 289 patients had other SSRD (mean age 42.1, SD = 13.3, 60.2% women). Patients completed a neuropsychological test battery that addressed a broad range of neurocognitive domains, including information processing speed, attention and executive functioning. Patients with CD/FND had clinically significant neurocognitive deficits in all neurocognitive domains based on normative data comparison. Patients with CD/FND also performed significantly worse than patients with other SSRD on information processing speed (Digit Symbol Substitution Test (V = .115, p = .035), Stroop Color–Word Test (SCWT) card 1 (V = .190, p = .006), and SCWT card 2 (V = .244, p < .001). No CD/FND vs. other SSRD differences were observed in other neurocognitive domains. These findings indicate the patients with CD/FND perform worse on information processing speed tests compared to patients with other SSRD.     

Impaired finger dexterity in Parkinson's disease is associated with praxis function

A controversial concept suggests that impaired finger dexterity in Parkinson’s disease may be related to limb kinetic apraxia that is not explained by elemental motor deficits such as bradykinesia. To explore the nature of dexterous difficulties, the aim of the present study was to assess the relationship of finger dexterity with ideomotor praxis function and parkinsonian symptoms. Twenty-five patients with Parkinson’s disease participated in the study. Their left and right arms were tested independently. Testing was done in an OFF and ON state as defined by a modified version of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Finger dexterity was assessed by a coin rotation (CR) task and ideomotor praxis using a novel test of upper limb apraxia (TULIA), in which the patients were requested to imitate and pantomime 48 meaningless, as well as communicative and tool-related gestures. Coin rotation significantly correlated with TULIA irrespective of the motor state and arm involved, but not with the MDS-UPDRS. This association was significantly influenced by Hoehn and Yahr stage.The strong association of finger dexterity with praxis function but not the parkinsonian symptoms indicates that impaired finger dexterity in Parkinson’s disease may be indeed apraxic in nature, yet, predominantly in advanced stages of the disease when cortical pathology is expected to develop. The findings are discussed within a cognitive-motor model of praxis function.     

Happiness and Personal Growth are Attainable in Interferon-Beta-1a Treated Multiple Sclerosis Patients

Multiple sclerosis (MS) is a chronic debilitating disease. MS is associated with high rates of depression and dissatisfaction with life. “Positive psychology,” (PoP) has endeavored to better understand happiness, meaning in life and how these can be developed. There is a growing interest amongst clinicians and consumers in happiness and personal growth as indicators of patients’ well-being. To evaluate happiness and personal growth in treated relapsing-remitting (RR) MS patients compared with age and gender matched healthy subjects. The Oxford Happiness Inventory (OHI), the Satisfaction with Life Scale (SLS) and the Personal Growth Initiative Scale (PGIS) were completed by 105 RR-MS patients [70 females, mean age 44.4 ± 13.3 years, Expanded Disability Status Scale (EDSS) 3.6 ± 2.3] and 87 healthy subjects (66 females, mean age 39.7 ± 11.5 years). Scores were correlated with disease and treatment related parameters. All patients were treated for at least 6 months with interferon-beta-1a (Rebif). Mean happiness scores in MS patients for the OHI (103.1 ± 17.0), the SLS (23.9 ± 6.8) and the PGIS (40.1 ± 7.6) were not statistically different from those of healthy subjects. Categorical analysis of the SLS demonstrated a different distribution wherein more MS patients were in the “dissatisfied” subgroup (SLS score < 20) as compared to healthy subjects (24.8% vs. 12.6%, p = 0.045), while rates were similar in the extremely satisfied subgroup (SLS ≥ 30). Happiness was scored similarly in treated RR-MS patients and healthy subjects despite a greater percentage of patients reporting being dissatisfied with their lives. These findings may reflect positive treatment effects, hedonic adaptation or their combination.